Ketogenic Rule #6: Tell Me What You Eat . . . & I Will Tell You Who You Are.

Eat More Bacon

How we look at lifestyle choices can often be from very different perspectives and those perspectives powerfully influence our diets.  Oh, by the way, today is National Pig Appreciation Day.  You probably didn’t know it, but  the holiday celebration was started in 1972 by sisters Ellen Stanley, a teacher in Lubbock, Texas, and Mary Lynne Rave of Beaufort, North Carolina.  According to Rave the purpose of National Pig Day is “to accord the pig its rightful, though generally unrecognized, place as one of man’s most intellectual and domesticated animals” (1).

“Why would you even think about this stuff?” you may be asking yourself.  I specialize in ketogenic diets, using fat to treat disease, lower cholesterol, reverse diabetes and lose weight.  Yes, you could call me a “fat doctor.” Bacon is approximately 45-50% fat and so, this specially cured super-food is one of those “wonder foods” that helps cure disease in the ketogenic world.


I had the opportunity to attend a low carbohydrate/ketogenic dietary medical conference this last weekend.  The world leaders in Low Carbohydrate, High Fat, Ketogenic diets from every corner of the globe all gathered together in Colorado to share knowledge about treating the diseases of civilization with diet.

The underlying theme was a focus on the use of fat and protein with more effectiveness. Even among “those who know,” opinions differ as to how much fat and how much protein.  I find it interesting that if you have a conversation with three doctors all together in the same room, you will end up with five opinions.  However, the cause of weight gain that we all agree on is excess production of insulin.  Increased insulin in the blood causes fat storage.  Weight gain is hormonal.

Wait . . . let me say it again.  We gain weight because of hormones, not because of over consumption of calories.

We have known for many years that carbohydrate restriction is so important for turning off the hormone signal to store fat (see The Dreaded Seven .  . . Seven Detrimental Things Caused By High Insulin Loads).  In my office, I recommend starting at less than 20 grams of carbohydrate per day.  This level of restriction seems to be most effective for most of my patients beginning the ketogenic lifestyle.  If you’re new to ketosis and/or low carb diets see my two articles about the principles of the Ketogenic Lifestyle: The Principle Based Ketogenic Lifestyle . . . Part I & Ketogenic Principles . . . Part II.

The magic that most people never realize is that in order for fat to become therapeutic in treating the diseases of civilization, you must increase your natural fat intake to greater than 50-60% of your total caloric consumption per day and lower your carbohydrate intake to less than 20 grams per day. However, even when carbohydrates lowered or eliminated, I still see a number of patient’s who hit plateaus with their weight. They often tell me that they are “strictly following their carbohydrate restriction,” and I believe that they are truly trying.  However, the lab work that we do regularly usually tells another story.  You see, inflammatory markers and hormones don’t lie. Insulin is a hormone that directly stimulates markers of inflammation.  Carbohydrates are not the only things that stimulate insulin.

If you are struggling with weight loss plateau’s, keep a food journal.  If you tell me what you eat, I’ll tell you why you’re gaining or not losing weight. Things that stimulate insulin and/or inflammatory response:

  • Carbohydrate intake > 20 grams in a 4-6 hour period of time ( or > 20 grams in 24 hours for those insulin resistant/diabetic patients)
  • Protein intake greater than needed for Ideal Body Weight. (See how to calculate your protein intake here.)
  • Stress response due to poor gut bacterial colonization
  • Poor absorption of B12, B6 due to MTHFR reduction or deficiency.
  • Environmental or Situational Stress
  • Chronic Infection or Injury
  • Starvation

Lab markers implying high insulin response or inflammation:

  • Fasting Insulin > 5 mU/ml
  • Triglycerides > 100 mg/dl
  • Small Dense LDL (sdLDL) Particle > 500 nmol/L
  • LDL-P > 1200 nmol/L
  • C-Reactive Protein Elevation
  • Erythrocytes Sedimentation Rate Elevation
  • Leptin > 20 ng/ml
  • Adiponectin <14 mg/ml
  • Testosterone (men) <300 ng/dl
  • Fasting Blood Sugars consistently > 110 mg/dl

If your weight is plateauing, the lists above will give you a starting point.  I recommend you follow up with your doctor, someone who can help tease out the subtle causes of plateauing weight loss.

While at the conference, I also got some great in depth education about using exogenous ketones like Keto//OS.  I’ve been watching their use from the periphery for quite some time.  My interest has been peaked in the last few months as I have seen some significant successes with their use.  In fact, I tried them out while skiing with my son at the conference.  This 46 year old  found he could keep up with his son due to increased energy, greater clarity of thought and appetite suppression while using them, as well as enhanced ability to maintain ketosis throughout the three days that I tried them out. The benefit of using exogenous ketones can also be found in a fuel source that doesn’t increase insulin, and has some documented effect on re-balancing bacterial colonies in the gut.  If you’re interested in using them for your ketogenic lifestyle (yes, this is the shameless plug for one of the supplements that I personally use), click on the image below.


KetoOS – Exogenous Ketones

I also tried using a new ADAPT high fat bars and fat shots.  These are a great option for high fat replacement or supplementation without all the “carbage.”

Adapt Bar Chocolate

Both products are fantastic options to add to the ketogenic lifestyle for the elite athlete or the busy mom who just needs a quick ketogenic snack while at her son’s soccer game.

See this evenings Periscope video about National Pig Appreciation Day and my answers to a number of burning ketogenic questions from around the world:

(Proceeds from affiliate sales go to covering the cost for continued great content here on


  1. A Pig-Out for porkers. February 23, 1980 Associated Press story reported in Virgin Islands Daily News

17 Comments on “Ketogenic Rule #6: Tell Me What You Eat . . . & I Will Tell You Who You Are.

  1. Dr. Nally, do you think that “saturated fat” sensitivity exists? I’ve seen Dr. Attia mention it as well as Franziska Spritzler, saying that about 30% of the population seems to better following a Mediterranean style keto diet. However based on this article, it sounds like you’re saying that the underlying cause of elevation of cholesterol while following keto could actually be related to un-diagnosed inflammation, which is quite intriguing to me!

    • Great question Carole. In the 10-11 years that I have been prescribing ketogenic diets I have never seen a patient “do better on a Mediterranean diet than a ketogenic diet.” I am one of the few that feels that everyone will do well with some degree of carbohydrate restriction. Yes, cholesterol is driven by subtle inflammatory hormonal stimuli – often driven by insulin. The labs don’t lie – we just have to understand the labs 🙂

      • Oh, to be clear, I wasn’t comparing keto to Mediterranean, but regular, full saturated fat keto to a lower saturated fat, higher MUFA fat, Mediterranean style keto diet. Still high fat, low carb, just different types of fats. I’m very inspired by your work and am eager to learn even more!

      • Understood. I am finding that real saturated animal fat is actually more effective in keeping the inflammation and cholesterol levels normal.

  2. Hi Dr. Nally,

    I am in ketosis and check with the keto is every morning. I am yellow mostly and today I saw a bit of red.
    1. Should I check more often throughout the day? How long after eating should we check for change?

    2. The keto os u talked about. What will it do for someone who is in ketosis already. I guess I am a bit confused as to why to use it.

    Love the periscope. Wish I caught it live!!

    • I have the same question as Jodi. Is this a supplement for days you may have gone overboard a bit on carbs or a daily thing?

      • If you have a Ketonix meter you there’s no cost to checking as often as you want. The challenge with the Precision Xtra testing meter is that the cost goes up the more you check. I’d start out checking once a day and 1-2 hours after meals that may be questionable to see how your body responds to the meals.

  3. Hi Dr. Nally,

    I really appreciate the periscopes. Great way to get lots of “pings” of information. I know I am stressed out due to grieving the unexpected death of my mother in November. I am trying to just maintain right now. Any tips on continuing weight loss while enduring this stress? I feel like my hunger is back out of whack, even while eating low carb. Thanks!

  4. Doc Nally can you please explain why keto os would help someone already in ketosis? Do u take it to be able to eat more carbs or protein and still stay in ketosis? I am confused.
    Thanks jodi

    • Jodi, I take it to help suppress my appetite and as an easy fuel replacement when I don’t have access to good animal fat sources.
      For instance, I am traveling this week and fast food offers a poor option for high fat low carb. Keto//OS is a great way to get ketones and stay full so I am not temped to cheat.

      • Ok now I get it.. I am traveling soon and it would be great to have a supplement that will keep me full without worrying where I am getting my food source from. Thanks Doc

  5. I am not losing, but my twin sister is. We eat the same. I was put on Deppo years ago. I was 125 pounds at the time. I have gained weight ever since. I have lost 30 pounds on Keto, and have stopped. (2 Months) I have not changed the way I eat. I am 75/20/5. I am not hungry, and have no problem eating only dinner.
    What can I do?

    • If you’re still on DepoProvera then this could very well be the problem. You need to see your doc and get your metabolism checked out (thyroid, female hormones, review of medications that can halt weight loss, etc.)

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